Dr. Sandeep Kharat (MBBS)
Most cold are caused by viral infections
Virus invade the mucosa of the upper respiratory
tract, nose, pharynx and larynx which leads to
the upper respiratory system.
Signs and symptoms: excessive mucous
production leads to sore throat, coughing, upset
Treatment: reduce symptoms
Note: antibiotics do not help viral infections
Has been shown in clinical trials to reduce cold
symptoms and recovery time when taken early in
Adverse effects: dermatitis, upset stomach,
dizziness, headache, and unpleasant taste.
Action: act directly on histamine receptor sites
Used as an inflammatory mediator for allergic
disorders, allergic rhinitis (hay fever and mold,
and dust allergies), anaphylaxis, angioedema,
insect bites and urticaria (itching).
Trade name: Benadryl
One of the oldest anti-histamines
Action: Antagonizes the effects of histamine
at the H1 receptor sites.
Adverse Effects: Significant CNS depressant:
drowsiness, dizziness, hypotension, dry
Onset: immediate to 60 minutes
Peak: 1-4 hours
Duration: 4-8 hours
The drugs were developed to eliminate the
unwanted adverse effects; mainly sedation.
Action: Works peripherally (do not cross the blood
brain barrier) to block the actions of histamine.
Generic name: loratadine
Trade name: Claritin
Action: blocks peripheral effects of histamine
released during allergic reactions.
Therapeutic Effects: decreased symptoms of
allergic reactions (nasal stuffiness, red
Onset within 1-3 hours
Peak within 8-12 hours
Duration: > 24 hours
Trade name: Zyrtec
Therapeutic classification: allergy, cold, and
cough remedies, antihistamine
Action: Antagonizes the effects of histamine at
H1-receptor sites; anticholinergic effects are
Onset: 30 minutes
Peak: 4-8 hours
Duration: 24 hours
Nasal congestion is due to excessive nasal
secretions and inflamed and swollen nasal
Three types of decongestants
ROUTE OF ADMINISTRATION
Orally to produce systemic effect
Inhaled: directly to lungs with some systemic
Nasally: local with some systemic effects
Adrenergic Drugs: topical application directly
into the nares provides a very potent
Main side effect: rebound effect (after a few days
of use if discontinued can have rebound
Often used prophylactically to prevent nasal
congestion in patients with chronic upper
respiratory tract infections.
Action: aimed at the anti-inflammatory response
Opioid drugs all have antitussive effects
Codeine is the only opioid used as a cough
Action: suppress the cough reflex through direct
action on the cough center in the CNS (medulla).
Adverse effects: CNS and respiratory depression
and addictive potential
Vicks Formula 44
Safe, non-addicting and does not cause CNS or
Aid in the coughing up and spitting out of the
excess mucous that has accumulated in the
respiratory tract by breaking down and thinning
Loosening and thinning the respiratory tract
Direct stimulation of the secretory glands in the
Guaifenesin is the only drug currently available.
Trade names: Robitussin, Humibid, Guiatuss
Therapeutic effect: relief of respiratory
congestion and cough suppression
Right side has 3 lobes
Left side 2 lobes
Contains the lower respiratory structures
Definition: The bronchi are small air passages,
composed of hyaline cartilage, that extend from
the trachea to the bronchioles. There are two
bronchi in the human body that branch off from
the trachea. The bronchi are lined with mucous
membranes that secrete mucus and cilia that
sweep the mucus and particles up and out of the
Have a very thin membrane that allows rapid
diffusion of oxygen and carbon dioxide between
capillary blood and alveolar air spaces.
Lined with surfactant to prevent alveolar
Essential fluid that lines the alveoli and smallest
Reduces surface tension of the lung allowing the
oxygen and carbon dioxide across the membrane.
NERVOUS SYSTEM ROLE
Nervous system regulates the rate and depth of
Medulla oblongata is the respiratory control
system of the brain.
Cough reflex is stimulated by nervous system.
DISEASES OF RESPIRATORY SYSTEM
Upper respiratory tract: colds, rhinitis, hay fever
Lower respiratory tract: asthma, emphysema and
All involve obstruction of airflow through the
Recurrent and reversible shortness of breath that
occurs when the bronchi and bronchioles become
narrow as a result of bronchospasm,
inflammation, and edema of the bronchial
mucosa, and the production of viscid (sticky)
Caused by hypersensitivity to an allergen or
allergens in the environment.
Allergen is substance that elicits an allergic reaction.
Antigen: Substance (usually a protein) that causes
the formation of an antibody and reacts with the
Antibody: Immunoglobulins produced by
Lymphocytes in response to bacteria, viruses, or
other antigen substances. (IgE)
STEPWISE THERAPY FOR
MANAGEMENT OF ASTHMA
Step 1: mild intermittent
TREATMENT OF MILD INTERMITTENT
Short-acting inhaled B2 agonists
Albuterol or Proventil
ALBUTEROL (SHORT ACTING
Therapeutic classification: bronchodilators
Pharmacologic classification: adrenergic
Indications: Used as a bronchodilator in the
management of reversible airway obstruction.
Action: Binds to beta 2-adrenergic receptors in
airway smooth muscle.
Therapeutic effects: bronchodilator
May give up to 3 treatments at 20 minute
If taking more than one inhaled medications take
5 minutes apart
Encourage fluid intake
Signs and symptoms of respiratory distress
If no relief need to call PMD or go to ED
Classification: Mast cell stabilizer
Trade name: Intal, NasalCrom
Indications: adjunct in the prophylaxis (long-
term control) of allergic disorders including
rhinitis and asthma
Action: prevents the release of histamine and
slow-reacting substance of anaphylaxis (SRS-
A) from sensitized mast cells.
Route: inhalation, solution for nebulization or
Generic name: fluticasone
Trade name: Flovent
Action: potent locally acting anti-inflammatory
and immune modifier.
Decrease frequency of asthma attacks
Prevention of pulmonary damage associated with
Adverse reactions and side effects:
EENT: hoarseness, oropharyngeal fungal infections
Dry mouth, esophageal candidia.
Take medication as directed.
Do not discontinue without consulting MD
When using corticosteroids and bronchodilators
use bronchodilators first and follow 5 minutes
later with corticosteroids.
Rinse and spit after inhalation therapy to
prevent oral fungal infections.
Use a tight fitting mask in infant / small child
New class of asthma drugs called leukotriene
Action: works on the immune system at the
Trade name: Singulair
Onset: 30 minutes
Peak: 3-4 hours
Duration: 24 hours
SEVERE PERSISTENT ASTHMA
High dose inhaled corticosteroids
PO prednisone or
If severe IV corticosteroids (Solu-Medrol)
Trade name: Solu-medrol
Action: suppress inflammation and the normal
Can be given IV, IM or PO
Intravenous systemic is used in acute asthma or
status asthmatic attack that does not respond to
Side effects of long term use:
Decreased wound healing
Cushingoid appearance: moon face, buffalo hump,
increased susceptibility to infection.
Given po after 3 doses of IV Methylprednisone
Dose: 5-60 mg per day for adults, dosing based on
EXERCISE INDUCED ASTHMA
Short acting B2 agonist
Take 15 to 20 minutes before activity
Increase fluid intake
Stay indoors when air quality is poor
Continuous inflammation of the bronchi.
Inflammation of smaller bronchi.
One of the most common causes is smoking.
Predisposing factors of pulmonary infections
Short acting beta 2 agonist
Cessation of smoking
Immunization against flu
Add one or more long-acting bronchodilators such
Inhaled Anticholinergic drugs such as Atrovent
TREATMENT OF COPD
Atrovent: long acting bronchodilator
Uses: bronchodilator in maintenance therapy of
airway obstruction due to COPD.
Action: inhibits cholinergic receptors in bronchial
Dosing: 2 puffs qid
Brand name: Serevent
Classification Pharmacologic: adrenergic
Classification Therapeutic: bronchodilator
Action: Produces accumulation of cyclic
adenosine monophosphate (cAMP) at the beta 2-
Use with caution: Cardiovascular disease,
Trade name: Theophyline, Slo-bid,
Action: increases level of cAMP (adenosine
monophosphate) which aids in dilation of
Indication: long term control of COPD
Adverse reactions: tachycardia, arrhythmias,
seizures, nausea and vomiting
How given: po or IV